Jun 082010

With such diverse people in the world that have individual needs and requirements, it is understandable that not everyone responds the same to every type of medication. Many people have specific conditions that prevent them from taking medicine using traditional manufactured pharmaceuticals. Sometimes the type of medicine required by a particular patient is not manufactured by traditional drug companies, or a patient may need to ingest the medicine using a different method than traditionally prescribed. This is when Compound Pharmacists come in to meet the unique individual patient needs.

Compounding pharmacists customize an individual patient’s prescription according to the specific need of the patient. There are a number of circumstances that require consultation with a compounding pharmacist. For instance, a patient will need a compound pharmacist if they are unable to ingest ingredients that are included in traditional medicines such as preservatives, alcohol, dyes, sugar, gluten, lactose, and casein. Patients may also need an alternate route of medicine ingestions such as if a patient has trouble swallowing. Alternate administration routes can include: Transdermal such as a skin patch, nasal spray, liquid form, lozenge, lollipops, creams, and inhalation. If a patient is susceptible to drug side effects or require allergen free medications, using medication prepared by a compounding pharmacist can drastically reduce the potential for side effects and eliminate allergic reactions. A compounding pharmacy can help cancer patients reduce discomfort caused by their medication during treatment.

If a patient requires a specific dosage that is not normally manufactured by a traditional drug manufacturer, a compounding pharmacist can provide the uncommon dosage in order to meet the required strength. Patients who are in need of medications that have been discontinued by pharmaceutical manufacturers can get the medications from a compounding pharmacist. As well, children who will only medications that have a palatable flavor will be able to get a specific drug that has a pleasant tasting flavor from a compounding pharmacist.

Compounded prescriptions are the ideal solutions for a patient that is in need of an alternate route of delivery and an uncommon dosage. Compounding pharmacists are needed in such medical areas as: Bio-identical Hormone Replacement Therapy, Sports Medicine, Wound Therapy, Veterinary practices that include both large and small animals, Chronic Pain Management, Dental Practices, Hospice, Pediatrics, Infertility, Ophthalmic, Dermatology, Neurology, Gastroenterology, and more.

Pharmacy compounding is not just a science of preparing medications, but it is also an art to customizing medications for patients. Compounding is not a new method of providing medications. This type of pharmacy has been around for centuries. However, with increasing more patients requiring alternative forms of drugs and innovations in technology and research, there has be a significant increase in compounding pharmacists. As well, The Food and Drug Administration support the use of compounding, and it is regulated by each State’s Board of Pharmacy.

With the consent of a physician, a compounding pharmacist can modify almost any kind of a medication to make it easier to ingest by the patient and have the exact same effect as traditional manufactured medicine. For many patients, compounding has made the ingestion much easier and less unpleasant. For patients who feel they may require the expertise of compounding pharmacists, it is recommended that they discuss what compounding can do for them with their physician.

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Aug 242009

Recently, I was asked the following question:

My doctor said I was hypothyroid and put me on Synthroid. I have been on Synthroid for 6 month, but I don’t feel any better. Why don’t I feel better and what can I do about it?

Synthroid contains T4 (levothyroxin) the main hormone produced by the thyroid gland, however T4 is not very active. The major active hormone is T3 (triiodothyronine). T4 has to be converted by the body to T3 to exhibit benefits as only T3 stimulates activity at the receptor sites.

There are many reasons why supplementation with just T4 may not be effective. If for any number of many reasons, the T4 (even with sufficient dosage) is not being converted to the active T3 form, you will not see the benefits of the thyroid supplementation.

There are many reasons why you might be hypothyroid. The most prevalent factor might simply be a lack of iodine. We all need some form of iodine. If we don’t get it in our diet, it is essential to take it in the form of supplements. The need for and lack of iodine is the reason why salt was iodized. However, with the current emphasis on decreasing salt intake, salt has lost its importance as an iodine source.

There are also many cofactors that are necessary for T4 to be converted to T3 such as zinc, copper, vitamins A, B2, B3, B6, and C. If any of these are missing in sufficient amounts, your supplemental T4 (Synthroid) will not be converted to T3 and you will still exhibit the symptoms of a low thyroid.

There are many factors that influence the enzyme which converts T4 to T3 such as: selenium deficiency, stress, heavy metal toxicity, dieting, inadequate protein intake, high carbohydrate diet, elevated cortisol, chronic illness, and decreased kidney or liver function.

In addition there are many medications that block this conversion such as beta blockers,   birth control pills, estrogen, lithium, phenytoin, theophylline, chemotherapy, glucocorticoids and clomipramine. There are also environmental toxins to consider such as dioxins, PCB, phtalates (chemicals added to plastics).

As you can see hypothyroidism can be very complicated and may need further investigation. Paying attention to your diet, supplementing with the appropriate supplements as previously mentioned, and dealing with stress issues are important first steps.

A better scenario than synthroid might be the use of dessicated thyroid. Dessicated thyroid derives from pig thyroid which is very close in composition to human thyroid i.e. a mix of T4 and T3. Adding supplemental sustained release T3 made by compounding pharmacists, along with adjustment to your synthroid dosage might also be helpful.

Treatment of thyroid dysfunction should be individualized and customized to each patient. It is therefore very important to work with your physician to solve your thyroid issues, keeping some of these options in mind.

Marvin Malamed,B.Sc.Phm.,C.C.N., has owned Haber’s Compounding Pharmacy for over 17 years. He is an award winning pharmacist and a certified clinical nutritionist. He can be contacted at marvin@haberspharmacy.com
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